Reliability and validity of the Premie-Neuro in detecting early neurodevelopmental delay and disability in preterm infants

Abstract

There are few reliable and valid methods available for clinicians to assess the functional neurological status of the preterm infant. In this study, we set out to determine whether the Premie-Neuro, a new standardized clinical neurological assessment for preterm infants, is a reliable, valid, and predictive tool. Thirty-four preterm infants were assessed twice, no more than 72 hours apart, using the Premie-Neuro. One assessment per infant was observed and scored by a second examiner. Infants continued to be administered the Premie-Neuro weekly through 37 weeks post-menstrual age or discharge from the neonatal intensive care unit (NICU). At discharge, infants' medical charts were reviewed to determine medical risk factors for neurodevelopmental delay. Follow-up testing was conducted at term adjusted age using the NeoNeuro and at 3 months adjusted age using the Infanib and Alberta Infant Motor Scale. Data were analyzed to determine interrater and test-retest reliabilities, construct validity, and predictive validity of the Premie-Neuro. Premie-Neuro raw scores--particularly those obtained close to NICU discharge--were reliable, valid, and predictive of performance at term and 3 months adjusted age. Premie-Neuro classifications (abnormal, questionable, or normal) based on the Premie-Neuro authors' recommended raw score cut-points were generally not reliable, valid, or predictive. After 34 weeks post-menstrual age (PMA), using a discharge Premie-Neuro raw score cut-point of 99 may be considered low-risk. Infants with scores ranging from 90-99 should be closely monitored to ensure that neurological abnormalities do not emerge. Using these criteria, the Premie-Neuro may be used to identify at-risk babies who will benefit from specialized services and/or close post-term follow-up. This has potential to improve effectiveness, efficiency, and outcomes of early supports and services provided to preterm babies.